Joined: 04 Sep 2008
|Posted: Mon Oct 27, 2008 8:49 pm Post subject: Pressure sores
|Pressure sores (commonly called bedsores) are an extremely serious and common problem for the elderly, bed-ridden patients, and paralytics. They come from too much pressure on certain parts of the body, especially those with little padding or which are frequently moist. Fortunately they are preventable. The Mayo Clinic website has a wonderful article talking about the causes, which can include smoking, incontinence, sharply titled beds, and poor nutrition. Prevention includes regular inspections, frequent position changes, the right kind of beds and pads. Check out this article on http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=preventionbedsores
Joined: 23 Jun 2009
|Posted: Tue Jun 23, 2009 1:09 pm Post subject:
|Please excuse the length of this. I have all this plus some more information on the subject of bedsores on my site:
First, I should say that my experience is with prevention, and you should discuss any treatment with a doctor.
Second, wound care is complex. The proper treatment, including the best ointments and cleaning materials to use, will depend on whether the sore is infected or not and whether it is wet or dry. Get expert medical treatment.
Bedsores are serious.
Bedsores are very serious, especially if they develop into open wounds. They don't heal easily, and can get worse quickly if not treated carefully and expertly. Bedsores are also commonly referred to as pressure ulcers or pressure sores. If you look up the bedsore topic online, these are the terms that are commonly used on the medical sites.
Bedsores are classified by stage, numbered one throuh four. Stage 1 is before it breaks the skin surface, while at Stage 4 it is an open wound all the way to the bone or tendon. Websites like Wikipedeia and others have pictures of sores.
Hopefully you will be able to identify the existence of a sore early in Stage 1, before it breaks the skin. At Stage 1 the area will look red or purple under the skin surface. If you touch it, it won't temporarily turn white, like a spot that is red from routine pressure would.
The areas that are susceptible and should be checked are those where the bone is close to the skin surface and subjected to pressure, such as the hips, lower spine (tailbone), heels, elbows, etc. These areas should be checked frequently, especially the tailbone area and heels.
At the very least, the skin should be fully examined at least daily, during the daily bathing. After the cleaning, the caregiver should be applying moisturizing lotion to the skin. As the lotion is applied to the entire body, check thoroughly for anything that could look like a developing sore. If you see a stage 1 sore, don't massage it, as this may cause further damage to the area under the skin. Also, you can sometimes identify that there is a sore from odor, so be sure to investigate to any foul smell.
If a bedsore is discovered, get professional medical treatment. At a very least, if these are discovered in a rehab or nursing facility, have them treated by a "Wound Care Nurse". Wound Care is a nursing specialty. Ask to speak with that nurse about the prescription for treatment. If the facility does not have a wound care nurse on staff, they should be able to arrange for one.
Make sure the prescribed treatment is followed. The dressing should always be dry, and should be changed according to schedule. My experience is that this often does not happen as you would think it might. In rehab facilities or acute care hospitals, there may be 15 patients assigned to each CNA and there might be only a few RN's on duty, so scheduled dressing changes can easily get overlooked.
I try to talk to the client's doctor about possibly prescribing specific cleansers and ointments, rather than have the staff rely on whatever is on hand at the facility.
I might Trust, but I also Verify, so I'll sometimes mark or date a bandage so I can be sure that it is being changed. More frequent changing is much better than a skipped changing. Also, even if it has just been changed minutes before, if the dressing gets wet or contaminated at all, make sure the wound is treated and changed all over again. Wounds in the tailbone area or hip can easily get contaminated. Don't compromise about having the wound cleaned all over again and the dressing changed if this happens, no matter how many times this need to be done.
If this is being treated in a rehab facility, find out when the wound care nurse is scheduled for a follow-up, so you can get the progress. That way you will also know that there actually is a follow-up.
My own opinion is that these sores are preventable. They occur on people who can't care for themselves, when the attention they require is not provided. These sores are painful. They come about when a person is left in one position so long that discomfort gradually builds up, until there is pain.
There are a number of things that can and should be done for prevention.
- Help the person shift frequently, at least every couple of hours.
- If the person can't move at all, consider getting a bed that can automatically shift.
- Be careful of pressure on bony areas, like the heel or lower spine.
- For people who can't move their feet, I always try to place a sheepskin pad under their heels, and sometimes even elbows.
- Be careful of causing friction burns from sliding on the bed.
- After bathing or cleaning, use a good moisturizing lotion. Don't let the skin get too dry.